submitted by Caroline McDonough, Esq.

Each day, we continue to learn more about the widespread impact COVID-19 is having on the world.  With the increased knowledge, comes an increased understanding and awareness of how quickly this virus is able to spread.  Thus, testing is crucial to the efforts to slow the spread of the virus while scientific and medical experts, all over the world, continue to work towards developing a vaccine to combat COVID-19.  Until an effective vaccine is developed, people will continue to seek out testing in order to know whether they are currently carrying the virus or potentially, through anti-body testing, determine whether they previously were a carrier of the virus.  Understandably, many people have concerns about medical bills they may incur as a result of seeking out testing for COVID-19.  The below information aims to answer some questions about when testing is covered by health insurance, and what to do if you receive a bill for COVID-19 testing that should have been covered.

What testing is available for COVID-19?

Generally, those undergoing testing for COVID-19 are receiving either a viral test or an anti-body test.  The viral test is used to identify whether someone currently has COVID-19.  The anti-body test aims to determine whether someone was previously infected.

I am enrolled in traditional Medicare.  Will I be billed for COVID-19 testing?

No. If you are enrolled in traditional Medicare, then your Medicare Part B will cover viral and antibody tests so long as the testing was done at a laboratory, pharmacy, doctor or hospital.  Thus, there should be no charge for either of these tests if you are enrolled in traditional Medicare.

I am enrolled in a Medicare Advantage plan (e.g. Blue Cross Blue Shield, Independent Health, United Healthcare, Univera Healthcare, etc.).  Will I be billed for COVID-19 testing?

No.  Medicare Advantage plans must provide the same benefits to its enrollees as those that would be available through Medicare Parts A and B, if they were enrolled in traditional Medicare (except for hospice).  While Medicare Advantage plans are permitted to require copayment and deductible amounts different from those of traditional Medicare, the federal regulations created in response to the current pandemic, make clear that Medicare Advantage plans cannot charge copayments, deductibles, or coinsurance for COVID-19 testing.  Thus, a Medicare Advantage enrollee should not be billed for COVID-19 testing.

I am enrolled in Medicaid in New York State.  Will I be billed for COVID-19 testing?

No.  Governor Cuomo has made clear that Medicaid enrollees are not to be charged for COVID-19 testing, including co-pays for testing.  Moreover, protections have been put into place in order to protect New Yorkers enrolled in Medicaid from what are commonly referred to as “surprise bills.”  Therefore, if a Medicaid enrollee undergoes testing for COVID-19 from an out-of-network provider, due to a referral made by an in-network provider, or if an out-of-network provider performs the testing at an in-network hospital or clinic, the Medicaid insurer must protect its enrollees from bills for testing services administered in these types of circumstances and render coverage.

I am not enrolled in Medicare, Medicare Advantage, or Medicaid but do have health insurance through a private insurer.  Will I be billed for COVID-19 testing?

Currently, the Coronavirus Aid, Relief, and Economic Security (CARES) Act requires all health insurance plans to cover the costs associated with COVID-19 testing.  Additionally, the CARES Act affords for certain protections when private health insurance enrollees have testing performed at out-of-network providers.  In these instances, the insurance company is required to reimburse the testing provider up to the cash price for testing.  The insurer must make the cash price available to the public, by listing it on its website.  Therefore, individuals enrolled in private health insurance plans should also not be billed for out-of-pocket expenses associated with COVID-19 testing.

What do I do if I receive a bill for COVID-19?

You should call your insurer and let them know that you believe this bill is wrong.  Currently, coverage is to be made available for COVID-19 testing, so subjecting enrollees to these charges is erroneous.  If for any reason your insurer does not make the appropriate adjustments, then you can appeal the bill.  When you receive either Explanations of Benefits (EOBS) or for traditional Medicare enrollees, a Medicare Summary Notice (MSN), in the mail, there will be appeal rights listed on these notices.  Be sure to check what your appeal deadline is in order to ensure it is submitted timely.

Generally, insurance providers will be covering COVID-19 testing for the foreseeable future.  However, it is important to understand that if one tests positive and needs subsequent medical treatment, there may be out-of-pocket costs associated with the treatment provided for COVID-19.  These costs will vary from plan to plan, and if you have concerns about what these costs will be, then you should contact your insurance plan directly for more information.

If you are in any way confused or have questions about what to do upon receiving a bill for COVID-19 testing, then you may call the Center for Elder Law & Justice’s Legal Advice Helpline at 1–844–481–0973.  You will be able to speak with an attorney who can provide you with further information and if necessary, connect you with an attorney who may be able to represent and assist you with your appeal.

PLEASE NOTE:  The information provided above is subject to change and should not be construed as legal or medical advice.

 

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